Use of Lasers in Oral Maxillofacial Surgery; a cross-sectional study done in Riyadh, Saudi Arabia

Badr Soliman Alhussain; Meshal Yousef Almanea; Abdullah Nasser Alharbi; Mohammad Saad Alali; Muhannad Ali Alraba; Ohood Bandar Alferm

doi:10.51847/Bljyrczej9

Archive \ Volume.12 2021 Issue 4

Use of Lasers in Oral Maxillofacial Surgery; a cross-sectional study done in Riyadh, Saudi Arabia

Badr Soliman Alhussain^1*, Meshal Yousef Almanea², Abdullah Nasser Alharbi³, Mohammad Saad Alali³, Muhannad Ali Alraba³, Ohood Bandar Alferm⁴

¹Department of Consultant Restorative, PSMMC, Riyadh, Saudi Arabia. ²Department of Oral and Maxillofacial Surgery, King Saud Medical City, Riyadh, Saudi Arabia. ³General practitioners, Private sector, Riyadh, Saudi Arabia. ⁴Department of Dentistry, National Guard Hospital, Riyadh, Saudi Arabia.

Abstract

This cross-sectional survey was aimed to assess the use of Lasers in oral maxillofacial surgery. The study subjects comprised of general dentists and specialists/consultants having experience of 1-10 years, and more than 10 years. The use of Lasers in oral maxillofacial surgery was measured using 24 items questionnaire. After ensuring the reliability of the questionnaire, differences across gender, clinical position, and clinical experience were seen using a statistical measure Chi-square through SPSS to determine the statistically significant differences (p<0.05). Findings 52.7% of the participants were female, and 89.7% were general dentists, with the majority having experience between 1-10 years. They rank their current knowledge regarding laser use overall as average (36.3%) and about its use in OMFS as good (37.3%). Findings revealed that female participants participated more than males and practicing as general dentists having experience of 1-10 years of experience, have good knowledge of laser, and use it in their practice. General dentists were only aware of the use of laser in cosmetic surgery and consider it useful in different problems. Both groups often use lasers in their practice, while about the usefulness of lasers in different problems, both groups' opinions vary.

Keywords: Lasers, Maxillofacial surgery, Cross-sectional, Riyadh

INTRODUCTION

As the first reported use of lasers dedicated to Oral and Maxillofacial surgery, Strong et al. may have utilized CO2 lasers to excision premalignant and malignant tumors, among other surgical procedures. Kaplan et al. used lasers to treat oral tumors in 1974 [1, 2].

When a laser is used instead of a scalpel, there is less bleeding. This creates a largely bloodless battlefield. Because of its heat effects, the laser also coagulates the surrounding region [3]. Hemostasis is performed using lasers by contracting the collagen of the vascular wall of arteries with diameters of up to 500 m. The vessel diameter is reduced as a result, and the bleeding is managed. This feature substantially simplifies the treatment of vascular defects as well as hemorrhage management [4].

Lasers can be used to perform all medical treatments that aid in prosthesis recovery [5].

According to several writers, the benefits of lasers over other traditional dental equipment include increased coagulation, resulting in a drier operative field for improved visibility. When there is tissue ingestion and directed warmth develops, this interaction occurs [6].

Literature Review

An audit article states about the laser utilized in the oral treatment that these days, the use of laser involves the standard utilization of different medicines and dental hardware. The headway of innovation and information on numerous applications in regular practice will build the utilization of laser and our consciousness of the wide scope of benefits related with a medical procedure and mending, "The clinical utilization of the laser is captivating for two reasons," said Dr. Theodore Maiman, the maker of the main laser. From one perspective, it is a confident mission, while on the other, it repudiates the underlying picture of the laser is a passing beam" [6].

Another review study on the application of laser in oral surgeries in 2020 by Karishna, R.N., states that laser dentistry is fascinating; good scientific principles require that novel laser applications for treating patients be explored with prudence and reasonable judgment. Specific laser technologies are likely to become a key part of modern oral and maxillofacial professional procedures in the coming time.

MATERIALS AND METHODS

Study Design

This is a cross-sectional study conducted among Saudi dental professionals using an online survey.

Study Sample

311 dentists from Riyadh city were utilized in this study.

Study Instrument

The online questionnaire consists of questions related to demographic data followed by questions including knowledge and attitude towards the lasers in general, then related to their use in oral and maxillofacial surgery. The questionnaire consisted of closed-ended questions. Consent was taken from the participants before beginning with answering the questions. Google forms were utilized as a mode of questionnaire building and distributing. Data were kept confidential and stored until their use.

Instrument Validity and Reliability

A pilot study was conducted by sending the survey to 20 participants. The data were inserted in SPSS version 22 to determine the reliability using Chronbach’s coefficient alpha (value: 0.781). The validity of the questionnaire was tested by sending it to experienced researchers in PSMMC, and changes were made according to their feedback and comments.

Statistical Analysis

Collected data were analyzed using SPSS version 22, where descriptive as well as inferential statistics were conducted. Comparisons between groups were made with the value of significance kept under 0.05 using the Chi-square test.

RESULTS AND DISCUSSION

In Table 1, frequency analysis, 52.7% of the participants were female, and 89.7% were general dentists, with the majority having experience between 1-10 years. In Table 2, both male and female participants were mostly general dentists, and more females with 10 years working experience compared to male dentists.

Male participants’ perception about the use of lasers in different kinds of problems varies between somewhat true and true. However, for female participants, it mostly lies on do not know. Tables 3 and 4 shows the differences across experience and qualification.

Table 1. Frequencies of responses
Questions		Frequency	Percent
Gender	Male	147	47.3%
Gender	Female	164	52.7%
Qualification	General dentist	279	89.7%
Qualification	Specialist/consultant	32	10.3%
Work experience	1-10 years	183 128	58.8%
Work experience	10+ years	183 128	41.2%
How do you rate your current level of knowledge regarding lasers overall?	Poor	101	32.5%
	Average	113	36.3%
	Good	97	31.2%
How do you rate your current level of knowledge regarding lasers used in OMFS?	Poor	102	32.8%
	Average	93	29.9%
	Good	116	37.3%
When were the lasers invented?	The 1910s	69 51 32 159	22.2%
	1930s		16.45%
	1950s		10.3%
	Don't Know		51.1%
How often do you use lasers in your practice?	Never	120 184 7	38.6%
	Often		59.2%
	Sometimes		2.3%
Can lasers be useful in performing biopsy procedures?	Not useful	22 105 76 108	7.1%
	Somewhat useful		33.8%
	Very useful		24.4%
	Don't know		34.7%
Can lasers be useful for surgical extraction procedures?	Not useful	39 65 84 123	12.5%
	Somewhat useful		20.9%
	Very useful		27.0%
	Don't know		39.5%
Can lasers be useful for Pre-prosthetic surgery?	Not useful	4 87 108 112	1.3%
	Somewhat useful		28.0%
	Very useful		34.7%
	Don't know		36.0%
Can lasers be useful for implantology?	Not useful	13 102 56 140	4.2%
	Somewhat useful		32.8%
	Very useful		18.0%
	Don't know		45.0%
Can lasers be useful for cosmetic surgery?	Not useful	1 87 127 96	.3%
	Somewhat useful		28.0%
	Very useful		40.8%
	Don't know		30.9%
Your perception about 'lasers effectively coagulate blood vessels in the field of operatory'?	Not true	21 122 62 106	6.8%
	Somewhat true		39.2%
	Very true		19.9%
	Don't know		34.1%
Your perception about 'lasers provides a reduced need for sutures'?	Not true	17 74 116 104	5.5%
	Somewhat true		23.8%
	Very true		37.3%
	Don't know		33.4%
Your perception about 'lasers causing increased pain 4-7 days postoperatively'?	Not true	31 72 71 137	10.0%
	Somewhat true		23.2%
	Very true		22.8%
	Don't know		44.1%
Your perception about 'lasers causing health hazard if beams are scattered or reflected'?	Not true	11 96 86 118	3.5%
	Somewhat true		30.9%
	Very true		27.7%
	Don't know		37.9%
	Don't know		40.2%
Which laser is indicated for pigmented lesions, vascular anomalies, plastic surgery?	Argon	108 75 101 27	34.7%
	Diode		24.1%
	Nd: YAG, Ho: YAG		32.5%
	Er, Cr: YSGG, ER: YAG		8.7%
Which laser is indicated for soft tissue procedures?	Argon	76 118 103 14	24.4%
	Diode		37.9%
	Nd:YAG, Ho: YAG		33.1%
	Er, Cr: YSGG, ER: YAG		4.5%
Which laser is indicated for hard tissue procedures?	Argon	13 87 106 105	4.2%
	Diode		28.0%
	Nd:YAG, Ho: YAG		34.1%
	Er, Cr: YSGG, ER: YAG		33.8%
Do you think you require more knowledge about lasers in oral maxillofacial surgery procedures?	Yes No May be	161 12 138	51.8% 3.9% 44.4%	51.8
	Yes No May be	161 12 138	51.8% 3.9% 44.4%	55.6

Table 2. Comparison across Gender
Questions		Male	Female	P value
Qualification	General dentist	137	142	.04
Qualification	Specialist/consultant	10	22	.04
Work experience	1-10 years	106	77	.000
Work experience	10+ years	41	87	.000
How do you rate your current level of knowledge regarding lasers overall?	Poor	59	42	.000
	Average	71	42
	Good	17	80
		147	164
How do you rate your current level of knowledge regarding lasers used in OMFS?	Poor	59	43	.000
	Average	69	24
	Good	19	97
How often do you use lasers in your practice?	Never	112	8	.000
	Often	32	152
	Sometimes	3	4
Can lasers be useful in performing biopsy procedures?	Not useful	10	12	.001
	Somewhat useful	51	54
	Very useful	49	27
	Don't know	37	71
Can lasers be useful for surgical extraction procedures?	Not useful	12	27	.000
	Somewhat useful	40	25
	Very useful	61	23
	Don't know	34	89
Can lasers be useful for pre-prosthetic surgery?	Not useful	2	2	.033
	Somewhat useful	41	46
	Very useful	62	46
	Don't know	42	70
Can lasers be useful for implantology?	Not useful	12	1	.000
	Somewhat useful	50	52
	Very useful	33	23
	Don't know	52	88
Can lasers be useful for cosmetic surgery?	Not useful	1	0	.000
	Somewhat useful	52	35
	Very useful	67	60
	Don't know	27	69
Your perception about 'lasers providing better healing as compared to scalpel wounds'?	Not true	4	3	.028
	Somewhat true	49	31
	Very true	42	59
	Don't know	52	71
Your perception about 'lasers provides a reduced need for sutures'?	Not true	8	9	.000
	Somewhat true	51	23
	Very true	55	61
	Don't know	33	71
Your perception about 'lasers causing increased pain 4-7 days postoperatively'?	Not true	23	8	.000
	Somewhat true	43	29
	Very true	32	39
	Don't know	49	88
Your perception about 'lasers being very expensive and need training'?	Not true	1	1	.000
	Somewhat true	44	34
	Very true	71	35
	Don't know	31	94
Which laser is indicated for soft tissue procedures?	Argon	55	21	.000
	Diode	64	54
	Nd:YAG, Ho: YAG	16	87
	Er, Cr: YSGG, ER: YAG	12	2
Which laser is indicated for hard-tissue procedures?	Argon	12	1	.000
	Diode	47	40
	Nd:YAG, Ho: YAG	70	36
	Er, Cr: YSGG, ER: YAG	18	87
Do you think you require more k2wledge about lasers in oral maxillofacial surgery procedures?	Yes	84	77	.099
	No	7	5
	May be	56	82

Table 3. Comparison across Qualification
Questions		Qualification		P-value
Questions		General dentist	Specialist/ consultant	P-value
Gender	Male	137	10	.055
Gender	Female	142	22	.055
Work experience	1-10 years	161	22	.156
Work experience	10+ years	118	10	.156
How do you rate your current level of knowledge regarding lasers overall?	Poor	98	3	.013
	Average	97	16
	Good	84	13
When were the lasers invented?	1910s	59	10	.010
	1930s	44	7
	1950s	25	7
	Don't Know	151	8
How often do you use lasers in your Practice?	Never	113	7	.048
	Often	161	23
	Sometimes	5	2
Can lasers be useful in performing biopsy procedures?	Not useful	3	19	.000
	Somewhat useful	95	10
	Very useful	74	2
	Don't know	107	1
Can lasers be useful for surgical Extraction procedures?	Not useful	31	8	.000
	Somewhat useful	63	2
	Very useful	63	21
	Don't know	122	1
Can lasers be useful for apicoectomy procedure?	Not useful	7	0	.000
	Somewhat useful	70	10
	Very useful	67	18
	Don't know	135	4
Can lasers be useful for implantology?	Not useful	12	1	.000
	Somewhat useful	90	12
	Very useful	37	19
	Don't know	140	0
Can lasers be useful for cosmetic surgery?	Not useful	1	0	.001
	Somewhat useful	72	15
	Very useful	110	17
	Don't know	96	0
Your perception about 'Lasers incise tissue more efficiently than a scalpel'	Not true	18	0	.000
	Somewhat true	83	23
	Very true	78	9
	Don't know	100	0
Your perception about 'histologically, wound shows less wound contracture and scarring'?	Not true	1	0	.071
	Somewhat true	59	7
	Very true	73	15
	Don't know	146	10
Your perception about 'lasers provides reduced need for sutures'?	Not true	8	9	.000
	Somewhat true	65	9
	Very true	103	13
	Don't know	103	1
Your perception about 'lasers causing delayed healing'?	Not true	48	19	.000
	Somewhat true	92	1
	Very true	10	4
	Don't know	129	8
Your perception about 'lasers causing health hazard if beams are scattered or reflected'?	Not true	10	1	.000
	Somewhat true	88	8
	Very true	65	21
	Don't know	116	2
Which laser is indicated for pigmented lesions, vascular anomalies, and plastic surgery?	Argon	95	13	.000
	Diode	69	6
	Nd:YAG, Ho: YAG	98	3
	Er, Cr: YSGG, ER: YAG	17	10
Which laser is indicated for hard tissue procedures?	Argon	13	0	.000
	Diode	60	27
	Nd:YAG, Ho: YAG	102	4
	Er, Cr: YSGG, ER: YAG	104	1
Do you think you require more knowledge about lasers in oral maxillofacial surgery procedures?	Yes	151	10	.037
	No	11	1
	May be	117	21

Table 4. Comparison across clinical Experience
Questions		Experience		P value
Questions		1-10 years	10+ years	P value
Gender	Male	106	41	.000
Gender	Female	77	87	.000
How do you rate your current level of knowledge regarding lasers overall?	Poor	66	35	.000
	Average	103	10
	Good	14	83
When were the lasers invented?	1910s	35	34	.000
	1930s	43	8
	1950s	30	2
	Don't Know	75	84
How often do you use lasers in your Practice?	Never	81	39	.000
	Often	97	87
	Sometimes	5	2
Can lasers be useful for vaporization and ablation procedures?	Not useful	12	07	.000
	Somewhat useful	55	20
	Very useful	66	17
	Don't know	50	84
Can lasers be useful for surgical Extraction procedures?	Not useful	36	03	.000
	Somewhat useful	49	16
	Very useful	74	10
	Don't know	24	99
Can lasers be useful for pre-prosthetic surgery?	Not useful	02	02	.000
	Somewhat useful	68	19
	Very useful	83	25
	Don't know	30	82
Can lasers be useful for implantology?	Not useful	12	01	.000
	Somewhat useful	64	38
	Very useful	49	07
	Don't know	58	82
Your perception about 'Lasers incise tissue more efficiently than a scalpel'	Not true	16	02	.000
	Somewhat true	87	19
	Very true	62	25
	Don't know	18	82
.Your perception about 'histologically, wound shows less wound contracture and scarring'?	Not true	00	01	.000
	Somewhat true	42	24
	Very true	70	18
	Don't know	71	85
Your perception about 'lasers causing delayed healing'?	Not true	59	08	.000
	Somewhat true	58	35
	Very true	12	02
	Don't know	54	83
Your perception about 'lasers causing health hazard if beams are scattered or reflected'?	Not true	10	01	.000
	Somewhat true	75	21
	Very true	62	24
	Don't know	36	82
Which laser is indicated for pigmented lesions, vascular anomalies, and plastic surgery?	Argon	69	39	.000
	Diode	73	02
	Nd:YAG, Ho: YAG	15	86
	Er, Cr: YSGG, ER: YAG	26	01
Which laser is indicated for soft tissue procedures?	Argon	67	09	.000
	Diode	85	33
	Nd:YAG, Ho: YAG	19	84
	Er, Cr: YSGG, ER: YAG	12	02
Do you think you require more knowledge about lasers in oral maxillofacial surgery procedures?	Yes	140	21	.000
	No	07	05
	May be	36	102

The present study was aimed to check the use of LASER in maxillofacial surgery. To analyze, non-parametric measure Chi-square was applied through SPSS. In frequency analysis, 52.7% of the participants were female, and 89.7% were general dentists, with the majority having experience between 1-10 years. They rank their current knowledge regarding laser use overall as average (36.3%) and about its use in OMFS as good (37.3%). 50.2% are not aware of laser's effectiveness in healing compared to scalpel wounds, and 37.3% said it is true that laser provides the need for sutures. 29% think laser's delayed healing is somewhat true, the majority do not know about that increased pain caused by the laser, and laser being expensive and need training. 34.7% consider Argon for pigmented lesions, vascular anomalies, and literature also reports it as a good choice for pigmented lesions [7], 37.9% consider Nd: YAG, Ho: YAG for soft tissue procedures, 34.1% consider it for hard tissues and 51.8% think they need more knowledge about laser in oral maxillofacial surgery procedures.

In the next analysis, gender differences were examined, finding reported significant differences. Both male and female participants were mostly general dentists, and more females have working experience of more than 10 years compared to male dentists. Females marked their knowledge good about laser as compared to males and its use in OMFS. The majority of both genders were not aware of when the laser was invented. Female dentists more often use lasers in their practice as compared to male dentists. Literature also tells that mostly male dentists are aware of different edge points of laser in dentistry. Almost 94.3% of participants know that [8]. Female participants think YAG, Ho: YAG for pigmented lesions. In contrast, male participants think Diode for this but literature reports Argon as a good choice for pigmented lesions, as mentioned in the above paragraph. For soft tissues, females consider YAG again while males consider Diode, and a review article also reports Diode as a good choice for soft tissues [6].

In subsequent analysis, comparison across education was carried out. General dentists have more experience than specialists, and they rate their knowledge about laser overall and its use in OMFS as good. General dentists were more aware of the laser's invention than specialist dentists and more often used laser in their practice. Specialists consider Argon for pigmented lesions while general dentists consider YAG for this; literature also reports Argon as a good choice for pigmented lesions. For soft tissues, specialists preferred Argon, while general dentists preferred Diode as reported by literature too [6].

In subsequent analysis, differences across clinical experience were tested. Females have greater experience as compared to males. Participants having experience of more than 10 years have good knowledge of laser and its use in OMFS, while those with experience of fewer than 10 years have average knowledge about it. Both groups often use lasers in their practice, while about the usefulness of lasers in different problems, both groups' opinions vary. At the same time, those with less than 10 years of experience agreed, and literature also reports that freshly graduated or those having less experience show interest in learning more about laser, and 69% are interested in getting training about this [8]. A few quantitative studies have been conducted on evaluating dentists' knowledge about laser and its uses, and the present research is a great addition to the existing body of knowledge about the current topic.

CONCLUSION

Findings revealed significant differences across gender, qualification, and clinical experience. Female participants participated more than males and practicing as general dentists having experience of 1-10 years of experience, have good knowledge of laser, and use it in their practice. General dentists were only aware of the use of laser in cosmetic surgery and consider it useful in different problems.

ACKNOWLEDGMENTS: Authors of this study would like to acknowledge the support and cooperation of the research center of PSMMC.

CONFLICT OF INTEREST: None

FINANCIAL SUPPORT: None

ETHICS STATEMENT: None